OBJECTIVES: To estimate the number of fee-for-service (FFS) Medicare beneficiaries with neurogenic bowel dysfunction (NBD) most likely to adopt Transanal Irrigation (TAI) after failing standard bowel care (SBC) provided that TAI was a Medicare benefit.

METHODS: Using the Medicare 2016-2021 FFS 100% Outpatient Standard Analytic File beneficiaries with a primary or secondary diagnosis of NBD (ICD-10 K59.2) were stratified by underlying conditions such as spinal cord injury/dysfunction diagnosis (SCI/D). We assumed that, given Medicare coverage, 14% of NBD patients would use TAI over a 10-year period, based on TAI adoption in France in a similar patient population.

RESULTS: The number of NBD patients enrolled yearly in Medicare FFS ranged from 3,463 to 5,932. Few of them continued to use outpatient care for NBD diagnosis year over year and as a result the number of patients with NBD in 2021 was only 7,200 or 18.3 per 100,000 population. Majority (70%) of NBD patients enrolled between 2016-2021 had a history of SCI/D. More than half of NBD patients were eligible for both Medicare and Medicaid (51%) compared to only 15% of the non-NBD population. Most (78%) NBD patients enrolled in Medicare were disabled. We estimated that about 1,000 NBD FFS beneficiaries will adopt TAI over a 10-year period based on adoption patterns observed in France.

CONCLUSIONS: The number of Medicare FFS beneficiaries with NBD that might adopt TAI is small. Further, the number of NBD patients enrolling in Medicare annually has remained stable over the last six years. Unlike the majority of State Medicaid plans, Medicare doesn’t cover TAI. Medicare beneficiaries with NBD are disadvantaged due to their disability and low income. The majority are dually eligible which can further limit their access to TAI compared to Medicaid beneficiaries, creating additional healthcare disparities for this patient population.